Provider Demographics
NPI:1063221034
Name:GMGPSYCHOLOGY
Entity type:Organization
Organization Name:GMGPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-489-1403
Mailing Address - Street 1:8414 FARM ROAD
Mailing Address - Street 2:STE 180 #1024
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8007
Mailing Address - Country:US
Mailing Address - Phone:202-489-1403
Mailing Address - Fax:
Practice Address - Street 1:9930 O LOUGHLIN MANOR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1299
Practice Address - Country:US
Practice Address - Phone:202-489-1403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty